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PubMed2002

Civil protection orders and risk of subsequent police-reported violence.

CONTEXT: Approximately 1.5 million US women experience intimate partner violence annually. Approximately 20% of these women obtain civil protection orders, but the effectiveness of such orders in preventing future violence is unclear. OBJECTIVE: To assess associations between obtaining a protection order and risk of subsequent police-reported intimate partner violence. DESIGN, SETTING, AND SUBJECTS: Retrospective cohort study of 2691 adult female residents of Seattle, Wash, with an incident of male intimate partner violence reported to the Seattle Police Department between August 1, 1998, and December 31, 1999. MAIN OUTCOME MEASURE: Relative risk (RR) of police-reported physical and psychological abuse in the 12 months following the index incident according to protection order status (temporary protection order, usually in effect for 2 weeks; permanent protection order, usually in effect for 12 months; or no protection order). RESULTS: Overall rates of police-reported physical and psychological abuse in the 12 months of follow-up were 13.5 per 100 person-years and 12.3 per 100 person-years, respectively. After controlling for cohabitation at time of index incident and index incident offense type, women with temporary protection orders in effect were more likely than women without protection orders to be psychologically abused (RR in the first 6 months after the index incident, 4.0; 95% confidence interval [CI], 2.2-7.2; RR in the entire 12 months after the index incident, 4.9; 95% CI, 2.8-8.6), while women with permanent protection orders in effect were less likely than those without orders to be physically abused (RR in the first 6 months, 0.4; 95% CI, 0.1-1.1; RR in the entire 12 months, 0.2; 95% CI, 0.1-0.8). CONCLUSIONS: Permanent, but not temporary, protection orders are associated with a significant decrease in risk of police-reported violence against women by their male intimate partners.

Adult↗
PubMed1984

Patient diagnostic, behavioral and demographic variables associated with changes in civil commitment procedures.

Examined diagnostic and demographic characteristics of six groups of voluntary and committed patients (N = 300) over a 3-year period in order to assess the impact of a change in civil commitment procedures in the state of Missouri. Committed and voluntary patients differed on the basis of several demographic and behavioral variables, including diagnosis, employment status, and instances of serious physical harm recorded on admission. No differences were found between patients committed under the old law (which stipulated that the presence of "mental illness" was a sufficient criterion) and patients committed under the new law (which requires the presence of serious physical harm as an essential criterion). These findings were interpreted to suggest that, in at least some settings, clinicians were restricting commitment to cases that gave evidence of physical harm prior to the enactment of new legislation.

Adult↗
PubMed1991

Rheumatic diseases among Civil War troops.

There are extensive existing medical records of Federal Civil War troops. More than 160,000 cases of "acute rheumatism" occurred among these soldiers, and acute rheumatic fever was known to be the main cause. Infectious arthritides were frequent but not understood; gout was rare. "Chronic rheumatism" was diagnosed more than 246,000 times; prolonged rheumatic fever and reactive arthritis following dysentery were probably the major causes. Over 12,000 soldiers were discharged because of chronic rheumatism, many with "lumbago," which was probably spondylarthropathy.

History, 19th Century↗
PubMed1980

Selective primary suture of the battle-injured colon: an experience of the Nigerian Civil War.

During the 1967-9 phase of the Nigerian Civil War, 38 primary sutures of battle-injured colons were carried out, with 3 deaths, all in patients with severe concomitant injuries to the liver, diaphragm and right iliac crest. In carefully selected cases--one-third of the total--primary suture was a safe and reliable technique for dealing with battle-lacerated colons. Although there was a substantial morbidity (71 per cent) from wound sepsis, there was also a considerable reduction in the period spent in hospital.

Adult↗
PubMed2004

Assessing risk for violence among male and female civil psychiatric patients: the HCR-20, PCL:SV, and VSC.

This study evaluated the predictive validity of violence risk assessments conducted using the HCR-20, the Psychopathy Checklist: Screening Version (PCL:SV), and by the Violence Screening Checklist (VSC) in a sample of 268 involuntarily hospitalized male and female psychiatric patients. Information pertaining to violence and crime was coded from medical charts and correctional records. The HCR-20/PCL:SV evidenced modest non-significant associations in postdictive assessments of inpatient violence among men. Moderate to strong significant associations were found between the HCR-20/PCL:SV and inpatient violence among women. Pseudo-prospective assessments using the HCR-20 and PCL:SV resulted in moderate to large relationships with violence and crime in men and women following community discharge. It is concluded that the VSC is a promising tool for assessing acute inpatient violence risk with men. Findings offer preliminary validation of the predictive validity of the HCR-20 and PCL:SV with female civil psychiatric patients.

British Columbia↗
PubMed1993

Calcium intake and 28-year gastro-intestinal cancer mortality in Dutch civil servants.

The association between calcium intake and gastrointestinal cancer mortality was investigated in a 28-year follow-up study. Data were obtained from a general health examination in 1953-1954 among Dutch civil servants and their spouses, aged 40 to 65 years. Information from 2,591 participants was used for this study. Risk analyses were performed using logistic regression models with the highest quintile of calcium intake as reference. No statistically significant relation between calcium intake and gastrointestinal cancer mortality is observed, although the risk estimate for women with the lowest calcium intake is substantial. Odds ratios (OR) were adjusted for age, energy intake and dietary fiber. After inclusion of other potential confounders to the models (body-mass index and smoking habits), the results hardly differed. Both men and women who died of colorectal cancer had a lower mean calcium intake compared to the rest of the population. For women this was statistically significant. Our results suggest that a low calcium intake may be related to gastrointestinal cancer mortality among women of this study population.

Adult↗
PubMed1993

Visceral obesity: a "civilization syndrome".

The controversial question of the relationship between obesity and disease has been considerably clearer after the demonstration in several prospective, epidemiological studies that the subgroup of central, visceral obesity is particularly prone to develop cardiovascular disease, stroke, and non-insulin dependent diabetes mellitus. Visceral obesity is associated with multiple central endocrine aberrations. The hypothalamo-adrenal axis is apparently sensitive to stimuli, sex steroid hormone secretion blunted, and hyperandrogenicity is found in women. In addition, there seem to be signs of central dysfunctions in the regulation of hemodynamic factors after stress, and growth hormone secretion appears to be particularly blunted. Several of these endocrine abnormalities are associated with insulin resistance, particularly glycogen synthesis in muscle. Fiber composition with low type I/type II ratio might be secondary to the prevailing hyperinsulinemia, but low capillary density in muscle may well be of importance. In combination with elevated turn-over of free fatty acids (FFA) this will probably provide powerful mechanisms whereby insulin resistance is created. Portal FFA, from the highly lipolytic visceral depots may, in addition, affect hepatic metabolism to induce increased gluconeogenesis, production of very low density lipoproteins as well as to perhaps inhibit clearance of insulin. By these mechanisms a Metabolic Syndrome Visceral adipocytes seem to have a high density of several steroid hormone receptors, directing steroid hormone effects particularly to these depots. The net effect of cortisol is apparently a stimulation of lipid storage, with opposing effects of sex steroid hormones which also facilitate lipid mobilization, regulations most often found at the gene transcription level. Growth hormone inhibits cortisol effects on lipid accumulation, and amplifies the lipid mobilizing effects of steroid hormones. The combined perturbations of hormonal secretions will therefore probably direct triglycerides toward visceral depots. Circulatory and nervous regulatory mechanisms require, however, more attention. The multiple central endocrine and nervous aberrations of visceral obesity suggest neuroendocrine dysregulations, and have features characteristic of the hypothalamic arousal seen after certain types of stress, alcohol intake, and smoking. Such factors can be traced to subjects with visceral fat accumulation. Standardized stress, eliciting a "defeat reaction" in primates is followed by an apparently identical syndrome. This integrated picture of the multiple symptoms of visceral obesity is based on epidemiological, clinical, experimental, cellular, and molecular evidence. The ingredients of positive energy balance, including physical inactivity, stress, smoking, and alcohol consumption are frequent features of modern, urbanized society. Visceral obesity may therefore be an expression of a "Civilization Syndrome."

Adipose Tissue↗
PubMed2000

A civil action and statistical assessments of the spatial pattern of disease: do we have a cluster?

A reported "cluster" of excess childhood leukemia cases and possible environmental causes in Woburn, Massachusetts, formed a key motivation for the events described in the popular book and motion picture A Civil Action. Although statistical methods to assess spatial clustering existed prior to the events in Woburn, increasing interest in environmental risk factors and recent developments in geographical information systems and data availability prompt increased attention to such methods and their application to public health data. In this article, we review statistical and epidemiological concepts involved in the analysis of disease clusters. We discuss data issues, outline some methodological approaches, and illustrate ideas using data regarding leukemia incidence in upstate New York for the years 1978-1982.

Child↗
PubMed1995

"True clinical fictions": medical and literary narratives from the Civil War Hospital.

Where to find stories of the "real" Civil War? Since Walt Whitman, observers have suggested the place to look is the military hospital. This paper offers a comparative analysis of medical case histories and literary stories written by S. Weir Mitchell, head contract-surgeon at one of the largest Union army research hospitals. I illustrate that Mitchell's case histories and stories were at once complementary and antagonistic in their use of medical knowledge and narrative technique as a means of achieving truth-value.

History, 19th Century↗
PubMed1993

Medical malpractice involving colon and rectal disease: a 20-year review of United States civil court litigation.

To determine objectively the causes of malpractice litigation involving colon and rectal disease, a retrospective review was undertaken of all cases tried in the U.S. federal and state civil court system over a 21-year period from 1971 through 1991. Ninety-eight malpractice cases were identified from a computerized legal data base, involving 103 allegations of negligence. Allegations fell into five major categories: 1) failure to timely diagnose disease, principally colorectal cancer and appendicitis (n = 44/103; 43 percent); 2) iatrogenic colon injury (n = 25/103; 24 percent); 3) iatrogenic medical complications during diagnosis or treatment (n = 16/103; 15 percent); 4) sphincter injury with fecal incontinence, resulting from anorectal surgery or midline episiotomy (n = 10/103; 10 percent); and 5) lack of informed consent, especially regarding extent of procedures or risk of endoscopy (n = 8/103; 8 percent). These data may aid in design of risk prevention strategies related to the diagnosis and treatment of colorectal disease.

Anal Canal↗
PubMed1996

The development of blood transfusion: the contributions of Norman Bethune in the Spanish Civil War (1936-1939).

Although the Spanish Civil War (1936-1939) has been the focus of many papers in many countries, there are few references concerning medicine during this war, and many of the related events and medical progress are not well known. Some of these events came to influence civilian and military medicine. Among these were advances in blood transfusion, in which the Canadian surgeon, Norman Bethune, played an important role, particularly in advocating transfusion of blood to soldiers at the front rather than at medical centres behind the lines. While much of Bethune's work, especially in Canada and China, is well known, 1-3 certain aspects of Bethune's work and his stay in Spain are worth reviewing.

Blood Transfusion↗
PubMed2006

[Frequency and causes of civil and criminal proceedings in radiology. Analysis of a survey].

The eagerness of German patients to go to court on account of actual or suspected malpractice of their physicians has increased over the years, as is the case in other Western countries. Media coverage has given rise to criticism of physicians and their services rendered more than before. This naturally also concerns the discipline of radiology, even though the probability of a radiologist being accused in a lawsuit is clearly minor in comparison to the surgical disciplines. In contrast to other fields, the X-ray pictures are always available for a second opinion. In this study, 4760 radiologists were sent a questionnaire by mail and 1503 answered. The questionnaires were evaluated regarding interrogative and informative data from pending or completed proceedings. Lawsuits were directed towards the assessment of examinations (38%), the actual performance of an examination (30%) and not towards providing patients with information as we had expected. Angiographies, mammographies, and radiographies were the most frequent reasons for instituting proceedings. The majority of litigating patients was between 40 and 50 years old. The proceedings led to civil convictions in 30% and criminal convictions in 5.5%. Of the physicians accused of incorrect conduct, 73% were of the opinion that they had been treated unjustly, 26% supported the reproach as justified, and the rest had formed no opinion. Physicians in private practice and senior consultants (70%) were most frequently sued.

Crime↗
PubMed1998

The growing belief that people with mental illnesses are violent: the role of the dangerousness criterion for civil commitment.

In response to a controversy concerning whether the stigma of mental illness has declined significantly in the United States in the past several decades, we assessed changes in public perceptions that mentally ill people are violent. Specifically, we compared answers to an open-ended question regarding respondents' understanding of the term "mental illness" from two nationally representative surveys, one conducted in 1950 and one in 1996. In an earlier paper, we reported the finding that perceptions of violence not only failed to decrease but actually increased significantly between 1950 and 1996. In this paper, we explore the possibility that the dangerousness criterion for involuntary commitment, widely adopted in the United States beginning in the 1960s, has contributed to the unexpected increase in perceptions that mentally ill people are dangerous. We find that, among respondents who mention violence in their description of a mentally ill person, the percentage who use "dangerous to self or others" phrasing to indicate this belief increased substantially, from 4.2% in 1950 to 44.0% in 1996. Moreover, eliminating these respondents from consideration, there was a slight decrease in perceptions of violence between 1950 and 1996. We discuss the possibility that the adoption of the dangerousness criterion, which was intended to protect the civil liberties of mentally ill persons, may also have had the unintended consequence of increasing the stigma of mental illness in the United States.

Adolescent↗
PubMedDate not supplied

Reed B. Bontecou, M.D.--his role in Civil War surgery and medical photography.

This third article on the subject of Civil War injuries and their surgical repair is devoted to Reed B. Bontecou, M.D., a New York surgeon who contributed greatly to the use of photography to document the casualties of the battlefield as seen in the Northern as well as the Southern states. Photographs of the wounded soldiers helped to verify the severity of their injuries, and helped to determine the degree and amount of the post-war pension payments. These photographs were one of the largest sources which were used in the creation of the Otis Archives of the present-day National Museum of Health and Medicine in Washington, D.C. Some of the wounded soldiers' photographs in the Otis Archives demonstrate the use of plastic surgery techniques to repair the wounded face, head and neck, torso, and the extremities by only a handful of Northern and Confederate surgeons including Gurdon Buck, J.S. Gouley and Henry B. Sands of New York City; H. Culbertson, U.S.V. of Madison, Wisconsin; J. Cooper McKee of Washington, D.C., W.W. Keen, Jr. of Philadelphia; and C.B. Gibson, P.A.C.S. of Richmond; S.H. Stout of Tennessee; and J.B. Bean, a dentist of Chattanooga.

History, 19th Century↗
PubMed2006

Medical-legal issues in headache: penal and civil Italian legislation, working claims, social security, off-label prescription.

Primary headaches can be considered simultaneously as symptom and disease itself, while secondary headaches are expressions of a pathological process that can be systemic or locoregional. Because of its subjective features, headache is often difficult to assess and quantify by severity, frequency and invalidity rate, and for these reasons it has often been implicated in legal controversies. Headache has seldom been considered in the criminal law, except when it represents a typical symptom of a disease whose existence can be objectively assessed (i. e. raised intracranial pressure). Therefore, in civil legislation it is not yet coded to start claiming for invalidity compensation. In particular, one of the most debated medical-legal questions is represented by headaches occurring after head injury. Headache is often the principal symptom at the beginning of several toxic chronic syndromes, with many implications, especially in working claims, and, more recently, it may be referred to as one of the most frequent symptoms by victims of mobbing (i. e. psychological harassment in the workplace). The National Institute for Industrial Accident Insurance (INAIL) scales (instituted by the law 38/2000) mention the "Subjective cranial trauma syndrome" and give an invalidity rate evaluation. With reference to other headache forms, no legislation really exists at the present time, and headache is only considered as a symptom of a certain coded disease. Requests for invalidity social pension and the question of off-label prescriptions (drug prescription for a disease, without formal indication for it) are other controversial matters.

Disability Evaluation↗
PubMed1977

Labour-intensive civil construction.

This paper presents the results of a literature review of the ergonomics of labour-intensive civil construction. The work capacity of Asian and European workers is compared. Metabolic rates and other factors limiting productivity presented in the literature are summarised. Comparison is made with the results of productivity measurements taken in India and Indonesia. The considerable scope and need for further work in this field is outlined.

Journal Article↗
PubMed1983

On the manual handling of wide-body carts used by cabin attendants in civil aircraft.

A study was made of manual handling of wide-body carts used in civil aircraft. Under laboratory conditions, 11 females adjusted their pushing and pulling forces on fixed carts to the maximum amount they perceived as acceptable with repeated exertions. Subsequently their ability to push and pull the carts was tested with maximum exertions. The initial forces required to just get a fully loaded cart in motion were measured for different inclinations of the floor on which the cart stood. In a DC-9 aircraft, floor inclination and flying speed were measured while climbing to cruising altitude and during descent prior to landing. The maximum acceptable force for repetitive exertions was, on average, 68 N. The maximum force was, on average, 270 N. No significant differences were found between the pushing and pulling forces. The findings in the experiments caused the Swedish National Board of Occupational Safety and Health to reduce its recommended limit for repetitive push and pull in this task from 200 N to 100 N. As a result the handling of wide-body carts in the DC-9 should be delayed until at least 14-15 minutes after take-off to fulfil the new recommendation. On short flights, for which the DC-9 is used, this is not possible without reducing the level of service. A follow-up project on the development of an improved cart is under way, incorporating changes suggested in this paper and elsewhere.

Journal Article↗